'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Scrapping boundaries could 'destabilise' rural practices, GPC warns

Doctors' leaders have agreed to talk to the Government over plans to scrap practice boundaries, but warned the move may intensify financial pressures on the NHS and could destabilise rural and suburban practices.

Health secretary Andy Burnham announced last week that all restrictions on where a patient can register would be removed by next autumn, while admitting that logistical questions over the move had yet to be resolved.

Pulse revealed in May that the Department of Health had already been encouraging PCTs to extend GP catchment areas to cover the whole trust, with patients allowed to register near work while continuing to receive care from a GP near home.

The BMA said it was open to discussions on the latest, more radical move - which the Conservatives had already said they supported - but warned of serious logistical and financial obstacles.

Dr Hamish Meldrum, BMA chair, said: ‘Doctors are always happy to discuss ways of improving quality and choice for patients. However, ending the current system would make home visits more difficult and costly for the NHS to fund.'

Dr Laurence Buckman, GPC chair, said the problems with crapping practice boundaries were ‘not insurmountable' but would require considerable thought:

‘Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability. Meanwhile, city centre practices would be inundated with requests for appointments at lunchtime and evenings, which would effectively limit patient choice.'

But Mr Burnham said the Government was now determined to act.

'Many of us lead hectic lives and health services should be there to make things easier,' he said in a speech to the King's Fund. ‘A busy mum needs flexibility - she may want to register at a practice near her children's school. Equally, a commuter may want to register near to work.'

The move was welcomed by the CBI and by private healthcare providers. Dr Mark Hunt, managing director of Care UK, said: ‘It will also provide a mechanism for good practices to grow and expand services to a greater number of patients.'

But GPs in commuter belts said they were worried about the implications.

Dr Shan Whitear, a GP in Hadleigh, Essex, said she was concerned about the impact of losing young, healthy patients.

'If you're losing out on younger people, it will be very difficult to claim for anything. It [the plan] will also make it harder for us to keep tabs on people, do QOF, and keep a proper disease register.'

Timeline: The many attempts to address registration

May 2009 – Pulse reveals that the Government has given PCTs the all-clear to relax rules on patient registration, so commuters can register near their work rather than where they live.